Biomedical subjects
Publications and source records attributed to J Grellet.
Technological advances currently allow safe percutaneous puncture of certain intra-abdominal collections, provided the indications and technical precision are imperatively respected. Our aim is to draw attention to success factors and the limits of this procedure.
This prospective study was conducted in 34 consecutive renal transplant patients. Pulsed doppler was used to evaluate the peripheral resistance (PR) in the transplant vessels. Under normal conditions, the PR of the graft is low, resulting in a continuous diastolic blood flow. The intensity of this blood flow was evaluated by means of a resistance index (RI), Pourcelot's index, calculated as follows: RI = systolic peak - end-diastolic peak/systolic peak This study demonstrated values for RI of 0.71 +/- 0.087 in 14 totally asymptomatic patients. In 10 cases of acute rejection, the RI increased to 0.91 +/- 0.12. The 7 patients with acute tubular necrosis had an RI equal to 1. In patients with cytomegalovirus infection of suffering from cyclosporin overdose, the RI was not modified in relation to asymptomatic subjects. This study demonstrates the existence of a rise in the PR in cases of acute rejection and acute tubular necrosis with a sensitivity of 90% and 100% respectively for these two diagnoses. However, this method cannot be used to distinguish between acute rejection and acute tubular necrosis.
This observation illustrates how difficult it is to interpret the intravascular signal observed with MRI in cases of portal hypertension. A signal occupying the entire lumen of the portal trunk and branches can be seen, which is constantly observed in the axial as well as coronal planes in the 3 series studied. It is hypointense relative to the liver on T1-weighted images, hyperintense on T2-weighted images: this appearance therefore perfectly mimicks portal thrombosis. Ultrasound combined with pulsed Doppler demonstrates the stagnant blood within the patent portal system. This kind of artifact, which is produced by a very slow flow or even by the standstill of flow, is much more difficult to recognize than the common flow artifacts; the criteria put forward by various authors to distinguish between artifacts and thrombosis are of no avail in this case. Examinations must able to confirm or rule out portal thrombosis in the case of portal hypertension with deceleration of flow. In practice, ultrasound studies, combined with pulsed Doppler in the best cases, is therefore indicated as a first-intension technique.
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The protal system of 45 normal patients have been retrospectively studied on spin echo MRI sequences (interleaved cuts): multiple artifacts have been evaluated and 24% of them were visualized at the portal system level. Thus, partial volume effect responsible for almost 25% of the artifacts is not always easily seen on a single sequence. Respiratory and aortic artifacts can deteriorate the visualization of the vascular lumen but cannot be confused with a thrombosis. Well-known artifacts, as slice entry phenomenon and even echo rephasing, represent more than 60% of the artifacts: they are readily recognized when they are typical and indicate flowing blood. On the contrary, an other artifact, representing less than 5% of the total and seen at the level of the left portal vein, simulates a thrombus, on T2 weighed images. We conclude that the frequency and polymorphism of the artifacts are limiting factors of MRI value in the diagnosis of portal vein thrombosis.
This observation illustrates the use of CT in the diagnosis of rectosigmoid hemangiomas and the assessment of their extension. The CT appearance of hemangiomas is very specific and therefore allows confirming a diagnosis that is often difficult to make with other radiological techniques and with endoscopy: phleboliths within the thickened rectal wall are a characteristic sign. CT is primarily required when radical surgery is contemplated due to disabling repeated proctorrhagia: it provides a better delineation of trans- and extraparietal hemangioma extension, knowing that adhesion (...).
We measured the concentrations of cefixime in the human lung in vivo in order to evaluate indirectly the effectiveness of this antibiotic in the treatment of pulmonary infections. Twenty-three patients undergoing lung surgery entered the study and received cefixime either 200 mg 12-hourly (4 times) or 400 mg every 24 hours (twice). Blood samples and tissue specimens were collected simultaneously during surgery 4 or 8 hours after the last dose. Cefixime concentrations were measured by HPLC. The penetration of cefixime in both normal and neoplastic lung tissue was significant. Four or 8 hours after a 200 or 400 mg oral dose, lung concentrations were higher than the MIC90 values for sensitive strains and therefore consistent with effective therapeutic activity. The pharmacokinetics of cefixime in blood and in lung tissue suggest that pulmonary infections could be treated with a 400 mg dose once a day.
The diagnostic value of lymphography and computed tomography (CT) in the assessment of lymph node invasion by bladder cancers has been compared on the basis of 30 observations. Although computed tomography apparently yields better results (reliability: 93%) than lymphography (reliability: 87%), these findings have no statistical significance. The study of literature shows that the statistical exploitation of the results was seldom carried out. The combination of both exploration techniques seems to improve predictive values, but this improvement was not statistically significant in our study.
The aim of this work is to describe the current surgical rectum resection techniques for the treatment of cancer and the corresponding radiological images. The authors emphasize the mechanical, "trans-suture" anastomoses and on the colo anal anastomoses with colic container, which radiologists will have to follow up postoperatively.
This study was conducted in 10 patients recently treated by peritoneal dialysis, and without a previous history of peritoneal disorders. Its aim was to determine the normal distribution of a two litre liquid effusion in the mesocolic recesses. A detailed description of the anatomy of the supramesocolic peritoneum precedes the study CAT scan results.
The assessment of the extent of kidney cancers with MRI and CT is compared in 40 patients. The appearance of the tumor with MRI is very variable but always heterogeneous. Specific MRI features (tumoral pseudocapsule) provide a higher overall reliability (OR) than with CT for the detection of expansion beyond the capsule and into the kidney: 80% for 60%. Although the overall reliability of MRI is similar to that of CT (92% for 86%), MRI has proved its superiority for the assessment of the limits of endovenous tumoral expansion because of natural flow/thrombus contrast and of the multiple incidences of exploration. There is no significant difference between MRI (OR = 91%) and CT (OR = 88%) or the detection of lymph node involvement. Invasion of neighboring organs is better assessed with multi-incidence MRI. According to Robson's classification, the OR of MRI (77%) is not significantly higher than that of CT (65%). MRI is still a time-consuming and expensive technique, which should be reserved for cases in which iodine is contraindicated and used as a second-intention technique after CT to confirm the invasion of the capsule if partial nephrectomy is indicated, or the better delineate venous or regional invasion which CT could not assess properly.
A case of encapsulating peritonitis complicating the course of familial Mediterranean fever is reported. This encapsulating peritonitis was responsible for abdominal pain and had a "pseudocystic" appearance on ultrasonography and computed tomography. Ultrasound guided aspiration produced a yellowish fluid rich in proteins and poor in cells. Surgical operation revealed a congested appearance of the peritoneum associated with a richly fibrinous appearance of the external wall of the mass. The differential diagnosis is discussed.
A precise method was developed for detecting muscular stiffness changes in the left ventricular hypertrophy by chronic pressure overload in rats (2 kidney-1 clip renal hypertensive rats). The technique of Quick-Release allowed the measurement of the "stress-strain" relation (delta-epsilon), the elastic stiffness (d delta/d epsilon) and the stiffness constant (K) in isolated papillary muscle from normal and hypertrophied hearts at rest and at the maximal time course of activation during isometric contraction. (Table: see text). The results of this study reported that the cardiac hypertrophy induced by experimental pressure overload was not associated with significant alteration of myocardial stiffness. So, it would seem that a muscular stiffness modification was unresponsible for the ventricular compliance change of clinical and experimental results.
This study investigate the effects of Nicardipine treatment on regression of left ventricular hypertrophy (LVH), coronary hemodynamic and myocardial mechanical performance. 30 Sprague-Dawley male rats were divided into 3 groups: sham operated rats control group (SHC), untreated hypertensive rats group (RHR-U), treated hypertensive rats group (RHR-N). Systemic and coronary hemodynamics were determined by using left atrial injection of radioactive microspheres, 16 weeks after clipping. Mechanical performance was measured on isolated papillary muscle from the same animal. Results (mean +/- SEM) (Table: see text). Nicardipine treatment (10 to 15 mg intraperitoneal dosage during 8 weeks), led to: an efficient but incomplete control of hypertension. a reduction of left ventricular mass in proportion lesser than pressure decrease. a raise of coronary blood flow at rest with inversion of flow distribution between endocardium an epicardium. a decrease of "maximal" coronary blood flow. a reversal of impaired myocardial mechanical parameters towards control values except for contraction timing parameters. Decrease of "maximal" coronary blood flow could have deleterious effects on cardiac function.
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Left and right internal pudendal arteriography was performed in 9 nonimpotent male patients (mean age 29 years) who had normal erections. Filling of distal branches of the internal pudendal artery and inter-pudendal anastomoses was improved by superselective catheterization of the anterior trunk of the internal iliac artery or an ischiopudendal trunk, and by the choice of hyperosmolar contrast medium. In the 5 cases where these conditions were fulfilled, filling of the distal branches of internal pudendal arteries was always symmetrical, or showed bifid artery with bilateral distribution on one side, except for the dorsal artery of the penis which appeared to be single in 2 cases. Interdependence between the two internal pudendal arteries was noted in 7 of 9 patients, through either direct anastomosis (7 cases) or bilaterally distributed deep artery of penis (2 cases).
Ultrasonographic features of six leiomyosarcomas of the inferior vena cava are described. In most cases, the presentation is typical enough to strongly suggest the histologic diagnosis. The tumor is usually greater than 10 cm long, hypoechoic, heterogeneous. Cystic components can be found. It is sharply demarcated from neighboring organs which are displaced. The mass is located at the very place of the inferior vena cava, the lumen of which is no longer seen. It is fusiform shaped, surprisingly sparing the aorta. Differential diagnosis along with other radiologic examinations, pathologic findings, and prognosis are discussed.